PharmacoEconomics & Outcomes News 692, p6 - 30 Nov 20131. Mihajlovic J, et al. Cost Utility Analysis of Everolimus in the Treatment ofCost-effective treatment options Metastatic Renal Cell Cancer in the Netherlands. 16th Annual European

Conference of the International Society for Pharmacoeconomics and Outcomesfor mRCC evaluated at ISPORResearch : abstr. PCN135, 2 Nov 2013.

2. Perrin A, et al. Cost of Care with Everolimus Versus Axitinib for Second-LineEverolimus may be a cost-effective option in second- Metastatic Renal Cell Carcinoma Patients in Canada. 16th Annual European

Conference of the International Society for Pharmacoeconomics and Outcomesline treatment of patients with metastatic renal cellResearch : abstr. PCN60, 2 Nov 2013.cancer (mRCC), according to a study conducted in the 3. Berghea F, et al. A Cost-Effectiveness Analyses of Using Sunitinib (Su) in First

Netherlands.1 Line of Metastatic Renal Cancer in Romanian Jurisdiction. 16th AnnualEuropean Conference of the International Society for Pharmacoeconomics andThe study used a Markov model, designed in line withOutcomes Research : abstr. PCN111, 2 Nov 2013.Dutch treatment protocols, to assess the cost 4. Stillman IO, et al. A Cost-Effectiveness Analysis of Axitinib and Sorafenib for2nd Line Treatment of Advanced Renal Cell Carcinoma (Rcc) after Failure ofeffectiveness of everolimus compared with bestCytokines in the United States (US). 16th Annual European Conference of thesupportive care. Cohorts were followed over 18 cycles,International Society for Pharmacoeconomics and Outcomes Research : abstr.

each cycle lasting 8 weeks. The analysis, performed PCN102, 2 Nov 2013.801085697from a healthcare perspective, showed an incremental

cost of €92 258/QALY, which is just below the uppercost-effectiveness limit recommended by WHO.However, sensitivity analyses revealed that the resultshave some uncertainty, being sensitive to estimates ofoverall survival gain. Everolimus had a 54% probabilityof being cost effective at the threshold for theNetherlands (€95 700).

Everolimus less costly than axitinib inCanada

Everolimus is a less costly treatment option in patientswith mRCC requiring second-line therapy, comparedwith axitinib, according to a study* conducted inCanada.2 The cost analysis, conducted from theperspective of a Canadian healthcare payer, estimatedthe total cost of treatment with everolimus at$Can24 931 and that of treatment with axitinib at$39 010. Costs (2011 values) included those associatedwith drug acquisition, adjusted for dose intensity, andthe treatment of adverse events, based on incidencerates from trial data. The main driver of the costdifference was axitinib’s high dose intensity, resulting inhigh drug-acquisition costs.

Assessing sunitinib, sorafenib, axitinibA study** conducted in Romania showed that

sunitinib was the preferred option as first-line treatmentof patients with mRCC, compared with bevacizumab +interferon or sorafenib.3 Using a Markov model with a10-year time horizon, the analysis showed sunitinib wasassociated with more QALYs than bevacizumab orsorafenib (1.86 vs 1.7 and 1.69, respectively). Theincremental cost of sunitinib was estimated at €14 000/QALY (2011 value), compared with sorafenib.Compared with bevacizumab, sunitinib was dominant(–€141 000).

In a US study†, axitinib was found to be not costeffective, compared with sorafenib, as second-linetreatment of patients with advanced RCC who did notrespond to treatment with cytokines.4 Using a cohortpartition model constructed from a US third-party payer,the total per-patient lifetime costs were estimated at$US242 750 for axitinib and $168 880 for sorafenib.Most of the cost difference was due to the higher drugacquisition costs of axitinib. With 1.3 and 1.2 QALYsgained for axitinib and sorafenib, respectively, theincremental cost of axitinib was estimated at $683 209/QALY, compared with sorafenib.* funded by Novartis Pharmaceuticals Canada Inc.** funded by Pfizer, Romania† funded by Bayer Pharma AG, USA

1

PharmacoEconomics & Outcomes News 30 Nov 2013 No. 6921173-5503/13/0692-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved